We analyzed the factors of importance for nonunion in series of 91 open fractures of tibial diaphysis which were treated with external fixation. Factors analyzed included, age and sex of the patients, the mechanism of injury, the amount of soft tissue damage, the grade of comminution, the level at which the tibia was fractured, the presence of an intact fibula, the presence of the multiple injuries, the type of the external fixation used(AO external fixator, EXTOR; monotube external fixator, Ilizarov), and the need to supplement the stability of the reduction. We found that the amount of soft tissue damage and comminution of the fracture played a role in the development of the nonunion.
Diaphyses ; External Fixators ; Fibula ; Fractures, Open ; Humans ; Multiple Trauma ; Tibia ; Tibial Fractures*

Some proto-oncogenes in human malignancies can be primary cause of carcinogenesis and can be correlated to histologic aggressiveness or prognosis. In this study, to define the role of c-myc and c-fos protooncogenes in multistage tumorigenesis of thyroid tumor and to correlate the expression of c-myc protooncogene with the degree of histologic aggressiveness and EORTC prognostic index in patients of thyroid carcinoma, 132 fresh specimens obtained at surgery from 71 cases of thyroid tumor were analysed by slot blot hybridization for the expression of c-myc and c-fos proto-oncogene, and 42 formalin-fixed paraffin-embedded tissues were analysed by immunohistochemical staining with monoclonal c-myc antibody and monoclonal Ki-67 antibody, and in 34 paraffin-embedded malignant tissues, the degree of histologic aggressiveness was determined, and in 42 cases of thyroid cancer, EORTC prognostic index were determined. And each item was compared to c-myc mRNA expression level. The results obtained were as follows: 1. The level of c-myc mRNA was significantly higher in malignant thyroid tissues as compared to normal or benign thyroid tissues(p=0.01). 2. The level of c-fos mRNA was similar in normal, benign and well differentiated thyroid carcinoma 3. There was no difference of c-myc mRNA expression levels between central and peripheral tumor tissues. 4. C-myc expression of normal tissues originated from cancer was higher than those from benign tumor(p=0.01) 5. A high level of c-myc mRNA in differentiated thyroid cancer corresponded to a high degree of histologic aggressiveness, although there was no statistically significant correlation between two. 6. High levels of c-myc mRNA were more frequently found in thyroid carcinoma with unfavourable prognosis, although there was no statistically significant correlation between c-myc mRNA expression and EORTC prognostic index or other prognostic factors such as age, sex, tumor size, tumor extent in thyroid carcinoma. 7. C-myc mRNA expression was statistically significantly correlated to the degree of immunohistochemical staining of monoclonal c-myc antibody(p=0.01). 8. C-myc mRNA expression was statistically significantly correlated to Ki-67 cell proliferative index score(p=0.005). On the basis of results, it can be suggested that overexpression of c-myc protooncogene in thyroid carcinoma is secondary phenotype of growth signal rather than primary cause of thyroid carcinogenesis, and expression of c-fos protooncogene was similar in normal, benign and malignant tumor tissues. C-myc may be useful prognostic indicator because there was some relationship between c-myc mRNA expression and EORTC prognostic index score or histologic aggressiveness score. And because c-myc correaltes significantly to Ki-67 cell proliferative index score, c-myc expression will be important growth signal in follicular cell of thyroid and have a role of progression of thyroid carcinoma.
Carcinogenesis ; Genes, fos ; Humans* ; Phenotype ; Prognosis ; Proto-Oncogenes ; RNA, Messenger ; Thyroid Gland* ; Thyroid Neoplasms

Total hip arthroplasty for ankylosed hip has a higher risk of failure due to the poor condition of the hip abductors and the altered configuration of the bone, which lead to poor positioning or fixation of the prosthesis. Fifty-one hips (42 patients) converted to total hip arthroplasty between March 1983 and March 1994 have been reviewed three to thirteen years six months after operation. The average period of follow-up was four years nine months. Twenty six of the patients were men and sixteen were women. The average age at the time of operation was 40 years old (range,19 to 70 years). Among the 51 hips, bony ankylosis were 27 hips and fibrous ankylosis were 24 hips, spontaneous ankylosis were 40 hips and surgical ankylosis were 11 hips. The duration of hip fusion was 13 years six months in the bony ankylosis and 16 years one month in the fibrous ankylosis. Preoperatively 33 cases had low back pain, ipsilateral or contralateral knee or hip pain. In asymptomatic 18 cases, conversion total hip arthroplasty was also performed for the management of functional disabilities due to severe malpositioned ankylosis. At the time of the last follow-up, 25 cases were free from pain and six patients had a mild degree pain on the hip, knee or thigh. In bony ankylosis, the postoperative average hip motion ranged from 1.1 degrees to 93.2 degrees (average arc of motion of 92.1 degrees). In fibrous ankylosis, the postoperative average hip motion ranged from 1.7 degrees to 96.6 degrees (average arc of motion of 94.9 degrees). The average Harris hip score was improved from 66 to 86.9 in bony ankylosis and from 49 to 89.5 in fibrous anklyosis. The postoperative leg length discrepancy was 1.1 cm in average. The postoperative complications included heterotropic ossification in 25 cases (49%), cup loosening in two cases (3.9%) and stem loosening in three cases (5.6%). As for the clinical results, 24 cases (89%) of bony ankylosis and 23 cases (96%) of fibrous ankylosis had satisfactory functional results at the last follow-up. In conclusion, the conversion total hip arthroplasty could provide functional improvement, pain relief and especially correction of leg length discrepancy in most cases of ankylosed hip.
Adult ; Ankylosis ; Arthroplasty, Replacement, Hip* ; Female ; Follow-Up Studies ; Hip* ; Humans ; Knee ; Leg ; Low Back Pain ; Male ; Postoperative Complications ; Prostheses and Implants ; Thigh

PURPOSE: We retrospectively analyzed open pulmonary thromboembolectomy in patients with acute and chronic pulmonary thromboembolism. MATERIALS AND METHODS: Between August 1990 and May 2005, 12 consecutive patients with acute and chronic pulmonary thromboembolism underwent open pulmonary thromboembolectomy at Yonsei Cardiovascular Center. Their mean age was 47.5 years, and 7 of the patients were female. Among 12 patients, 5 had acute onset, and 7 had chronic disease, and 9 patients were associated with deep venous thrombosis. Extent of pulmonary embolism was massive in 3 patients with hemodynamic instability, and submassive in 8 patients. Preoperative echocardiogram revealed elevated right ventricular pressure in all patients, and 7 patients were in NYHA functional class III or IV. Pulmonary thromboembolectomy was performed in all patients under total circulatory arrest. RESULTS: There were 2 hospital deaths (16.7%). Among the patients who survived, mean right ventricular pressure was decreased significantly from 64.3mmHg to 34.0mmHg with improvement of NYHA functional class. CONCLUSION: Open pulmonary thromboembolectomy is thought to be an immediate and definitive treatment for massive pulmonary embolism with optimal results. Even though operative mortality is still high, early diagnosis and immediate surgical intervention in highly selective patients may improve the clinical outcome.
Adult ; Aged ; *Embolectomy/mortality ; Female ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Prognosis ; Pulmonary Embolism/mortality/physiopathology/*surgery ; Retrospective Studies ; Vena Cava Filters

PURPOSE: Recently Tc99m MIBI (methoxyisobutylisonitrile) has been described as an alternative to thallium for localizing parathyroid lesions. The purpose of this study was to compare the efficacy of a Tc99m MIBI scan with a Tl201/Tc99m subtraction scan for localizing parathyroid lesions in patients with primary hyperparathyroidism. METHODS: Among 31 cases of primary hyperparathyroidism operated on at the Department of Surgery, Seoul National University Hospital from January 1997 to June 2001, a Tl201/Tc99m subtraction scan was performed on 16 patients and a Tc99m MIBI scan on 22 patients. Seven patients underwent both. RESULTS: The pathology was a single adenoma in 28 patients, a hyperplasia in 1 patient and a carcinoma in 2 patients. Hypercalcemia was controlled postoperatively in all cases. The sensitivities of the Tl201/Tc99m subtraction scan and Tc99m MIBI scan were 53.3% and 86.4%, respectively. The positive predictive values were 100% of the two study groups. CONCLUSION: We concluded that the better accuracy, superior image quality and lower cost of Tc99m MIBI scan will make it the new radiopharmaceutical parathyroid scan of choice. A unilateral approach can be used with a high degree of success, as in case of a preoperatively localized single parathyroid adenoma, which was confirmed when surgical exploration identified of a normal ipsilateral gland.
Adenoma ; Humans ; Hypercalcemia ; Hyperparathyroidism, Primary* ; Hyperplasia ; Parathyroid Neoplasms ; Pathology ; Seoul ; Thallium

BACKGROUND: To determine the prevalence of chronic fatigue syndrome and idiopathic chronic fatigue in Korea and to describe demographic, clinical, and psychological differences among those with chronic fatigue syndrome (CFS), those with idiopathic chronic fatigue, and healthy controls. METHODS: 1,526 persons aged 18-76 years who visited Korea university hospital health management center for general check-up between December 1998 and August 1999 were participated in the study. The questionnaire made according to the Centers for Disease Control and Prevention criteria was administered to the recruited persons and patients with chronic fatigue syndrome were diagnosed by questionnaire, physical examination and laboratory tests. The Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) was used to assess depression. RESULTS: Of the 1,526 persons studied, 433 (29.4 %) reported severe fatigue lasting at least 6 months. Of the 202 persons with unexplained chronic fatigue, 31 persons (2.0% of the study population) were classified as CFS cases. The prevalence of CFS was 2.81% in women, 1.49% in men respectively (p<0.05). When CES-D cut-off score of 25 was used, 30.43% of persons with CFS and 5.93% of persons without chronic fatigue had scores suggestive of depression. CFS patients had higher mean scores on CES-D than persons without chronic fatigue (p<0.05). CONCLUSION: Persons who met the criteria for chronic fatigue syndrome were found in 2.0%. The prevalence of chronic fatigue syndrome in our study were high, compared with previous studies in other countries. CFS patients had higher mean scores on CES-D than persons without chronic fatigue.
Centers for Disease Control and Prevention (U.S.) ; Depression ; Fatigue ; Fatigue Syndrome, Chronic* ; Female ; Humans ; Korea ; Male ; Physical Examination ; Prevalence* ; Surveys and Questionnaires

BACKGROUND: Patients diagnosed as an advanced cancer and families need accurate information about the length of survival in order to plan for and to make the best use of the time that remains. The health care of that patient can then be redirected toward palliation and mobilizing resources to ensure a comfortable life. The purposes of this study were to evaluate the prognostic value of performance status plus some physical symptoms and some biological indices and there fore to assist in planning appropriate palliative care. METHODS: This study was performed on 161 patients, who had been diagnosed as advanced cancer in Korea University Guro Hospital from July 1999 to July 2000. : We requested Karnofsky performance status scale, mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea and dry mouth We assessed the biological indices by leukocyte count, plasma albumin, proteinuria. RESULTS: We could confirm 82 patients' death(54.37) of 151 patients. Univariate analysis showed that Karnofsky performance status scale, mental status, jaundice, severity of pain, anorexia, voiding difficulty, dyspnea, dry mouth, leukocyte count, albumin and proteinuria demonstrated a statistically significant predictive prognosis. Multivariate analysis using Cox's proportional hazard model showed that age, performance status, albumin, proteinuria were independent predictors of survival and severity of pain had the borderline value. CONCLUSION: Age, performance status, albumin and proteinuria were the independent prognostic factors for patients with advanced cancer.
Anorexia ; Delivery of Health Care ; Dyspnea ; Humans ; Jaundice ; Karnofsky Performance Status ; Korea ; Leukocyte Count ; Mouth ; Multivariate Analysis ; Palliative Care ; Prognosis ; Proportional Hazards Models ; Proteinuria ; Serum Albumin

BACKGROUND: When it comes to wasting blood components, it usually means wastage before transfusion due to several reasons such as improvement of the patient's condition, death of the patient, delay of blood returning, etc. Yet blood components can sometimes can be wasted after a transfusion is started and this is referred as residual blood wastage. In this study, we analyzed the rate and causes of discarded blood components that are not used and the residual blood wastage in order to help reduce the rate of blood component wastage. METHODS: From January 2009 to December 2010, the number of and the reasons for discarded blood components without use and residual blood wastage were analyzed by reviewing the laboratory information system and wastage statements at Soonchunhyang University Seoul Hospital. RESULTS: The number of blood components issued during the study period was 24,001 units. Among them, the number of units discarded without use was 162 units (0.7%) and the number of units of residual blood wastage was 115 units (0.5%). Among the reasons for the discarded blood component without use, improvement of the patient's conditions ranked as 1st with 80 units (49.5%) and death of the patient ranked as 2nd with 42 units (25.9%). The biggest reason for the residual blood wastage was transfusion-related side effects with as many as 52 units (45.2%). Other than side effects, the wastage of residue from pediatric transfusion were 48 units (41.7%), followed by delay of surgery with 5 units (4.3%) and patients' refusal with 4 units (3.5%). CONCLUSION: The wastage of residue from pediatric transfusion was the second most common cause of residual blood wastage in our hospital. According to this, we should evaluate the routine use of pediatric transfusion bags and their cost-effectiveness in our hospital.
Clinical Laboratory Information Systems ; Disulfiram ; Humans ; Korea

BACKGROUND: Helicobacter pylori(H. pylori) is an important etiologic agent for chronic active gastritis and plays a role in the pathogenesis of peptic ulcer and stomach cancer and recently lymphomas occurring in mucosa associated lymphatic tissue. At present, H. pylori infection associated gastritis was estimated about 80% among the cause of chronic gastritis. In this study, we tested Polymerase Chain Reaction (PCR) assay to detect H. pylori infection in gastric biopsy specimens. This results were compared with results obtained by other tests. METHODS: A total of 70 patients with dyspepsia were evaluated for H. pylori infection through the use of PCR, culture and serologic tests. The study population had an age of 12 to 80 years(median 46.4), there were 31 males and 39 females. We tested PCR using H. pylori detection kit(TM) (Bioneer, Korea) and anti-H. pylori anti-body EIA using GAP test IgG and IgM(TM)(BIO-RAD, USA). We used anaerobic jar without catalyst for the microaerophilic condition. RESULTS: The positive result by PCR assay for diagnosis of H. pylori infection in gastric specimens was 71.4% in total of 70 patients, which the gastritis, peptic ulcer and gastric cancer were 63.2%, 77.8% and 85.7%, respectively. Among 10 gastrectomy specimens of stomach cancers, the detection rate of H. pylori infection by culture was 50% and the PCR assay was 100%. The detection rate of If pylori IgG and IgM antibodies by commercially available GAP test IgG and IgM EIA were 64.3%, respectively, and IgG or IgM were 85.7%. CONCLUSIONS: The serologic study was sensitive but it was appeared that the high false positive (75%) and false negative (25%) rate and could not confirm current infection. The PCR assay was shown to be more sensitive, rapid and easy to treat specimen for the detection of H. pylori infection than conventional methods such as culture and serologic test in dyspeptic patients.
Antibodies ; Biopsy ; Diagnosis ; Dyspepsia ; Female ; Gastrectomy ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Lymphoid Tissue ; Lymphoma ; Male ; Mucous Membrane ; Peptic Ulcer ; Polymerase Chain Reaction* ; Serologic Tests ; Stomach Neoplasms

BACKGROUND: Helicobacter pylori(H. pylori) is an important etiologic agent for chronic active gastritis and plays a role in the pathogenesis of peptic ulcer and stomach cancer and recently lymphomas occurring in mucosa associated lymphatic tissue. At present, H. pylori infection associated gastritis was estimated about 80% among the cause of chronic gastritis. In this study, we tested Polymerase Chain Reaction (PCR) assay to detect H. pylori infection in gastric biopsy specimens. This results were compared with results obtained by other tests. METHODS: A total of 70 patients with dyspepsia were evaluated for H. pylori infection through the use of PCR, culture and serologic tests. The study population had an age of 12 to 80 years(median 46.4), there were 31 males and 39 females. We tested PCR using H. pylori detection kit(TM) (Bioneer, Korea) and anti-H. pylori anti-body EIA using GAP test IgG and IgM(TM)(BIO-RAD, USA). We used anaerobic jar without catalyst for the microaerophilic condition. RESULTS: The positive result by PCR assay for diagnosis of H. pylori infection in gastric specimens was 71.4% in total of 70 patients, which the gastritis, peptic ulcer and gastric cancer were 63.2%, 77.8% and 85.7%, respectively. Among 10 gastrectomy specimens of stomach cancers, the detection rate of H. pylori infection by culture was 50% and the PCR assay was 100%. The detection rate of If pylori IgG and IgM antibodies by commercially available GAP test IgG and IgM EIA were 64.3%, respectively, and IgG or IgM were 85.7%. CONCLUSIONS: The serologic study was sensitive but it was appeared that the high false positive (75%) and false negative (25%) rate and could not confirm current infection. The PCR assay was shown to be more sensitive, rapid and easy to treat specimen for the detection of H. pylori infection than conventional methods such as culture and serologic test in dyspeptic patients.
Antibodies ; Biopsy ; Diagnosis ; Dyspepsia ; Female ; Gastrectomy ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Lymphoid Tissue ; Lymphoma ; Male ; Mucous Membrane ; Peptic Ulcer ; Polymerase Chain Reaction* ; Serologic Tests ; Stomach Neoplasms